Invasive Technique For Patients Research Articles

Evaluation Of Pterygomaxillary Disjunction with Interpositional Y-Shape Plate as An Innovative Minimally Invasive Technique in Patients with Temporomandibular Joint Internal Derangement (Clinical Trial)

Evaluation Of Pterygomaxillary Disjunction with Interpositional Y-Shape Plate as An Innovative Minimally Invasive Technique in Patients with Temporomandibular Joint Internal Derangement (Clinical Trial)

Very early onset perinatal constipation: Can it be cow's milk protein allergy?

Delayed passage of meconium or constipation during the perinatal period is traditionally regarded as a signal to initiate further work up to evaluate for serious diagnoses such as Hirschsprung's disease (HD), meconium ileus due to Cystic Fibrosis, etc. The diagnosis of HD particularly warrants invasive testing to confirm the diagnosis, such as anorectal manometry or rectal suction biopsy. What if there was another etiology of perinatal constipation, that is far lesser known? Cow's milk protein allergy (CMPA) is often diagnosed in infants within the first few weeks of life, however, there are studies that show that the CMPA allergen can be passed from mother to an infant in-utero, therefore allowing symptoms to show as early as day one of life. The presentation is more atypical, with perinatal constipation rather than with bloody stools, diarrhea, and vomiting. The diagnosis and management would be avoidance of cow's milk protein within the diet, with results and symptom improvement in patients immediately. Therefore, we discuss whether an alternative pathway to address perinatal constipation should be further discussed and implemented to potentially avoid invasive techniques in patients. This entails first ruling out CMPA with safe, noninvasive techniques with diet modification, and if unsuccessful, then moving forward with further diagnostic modalities.

Translated article] Arthroscopic tibiotalocalcaneal arthrodesis. Technique, indications and results

BackgroundArthroscopic tibiotalocalcaneal arthrodesis with a retrograde nail is performed as a minimally invasive technique in patients without improvement in conservative treatment of osteoarthritis. Complications and hospital stay after surgery are less using this technique when they are compared with open ones. Materials and methodsWe review retrospectively from 2016 to 2019 seven patients subjected to a posterior arthroscopic tibiotalocalcaneal arthrodesis with a retrograde intramedullary nail. AOFAS scale was used to assess functional results and we collected other data as complications, time required for bony union, time of nonweight-bearing and scale of satisfaction. We also made a description of the technique we performed. ResultsThe mean hospital stay was 3.43±0.53 days, patients have well functional results and complications were very low. It was noticed tibiotalar bony union in about 86% of patients 10 weeks after surgery and subtalar bony union in about 71% 20 weeks after surgery. Nonweight-bearing was made using a cast for 4 weeks and later, it was changed for Walker allowing patients partial weight-bearing until 10 weeks after surgery. One patient had wound complications and he needed later surgery and another presented tibiotalar pseudoarthrosis, although without symptoms. ConclusionPosterior arthroscopic tibiotalocalcaneal arthrodesis offers very good results with a high rate of bony union, few complications, and minimal nonweight-bearing time. This technique could be used in patients without major deformities, especially in those at high risk of complications from the surgical wound.

Ретроспективный анализ малоинвазивных методик лечения нервно-мышечных заболеваний пищевода (ахалазии кардии, кардиоспазма)

Most neuromuscular diseases of the esophagus (achalasia of the cardia, cardiospasm) lead to a decrease in the quality of life of patients, leading to symptoms such as difficulty in passing solid and liquid food through the esophagus (dysphagia 1-4 degrees), regurgitation, in some cases chest pain, with severe coughing and weight loss. The etiology remains unknown. Currently, there is no single standard for the treatment of patients with neuromuscular diseases of the esophagus. This work was carried out in order to assess the immediate and long-term results of surgical treatment of patients with neuromuscular diseases of the esophagus. The article presents an analysis of the results of repeated operations in 34 patients after surgical treatment of achalasia of the cardia and cardiospasm, conducted on the basis of the oncological department №2 of the RCOD (Kazan) and thoracic department №2 of the RCH of the Ministry of Health of the Republic of Tatarstan. Total on the basis of the oncology department № 2 of the RCOD (Kazan) and Thoracic Department №2 of the RCH of the Ministry of Health of the Republic of Tatarstan performed 353 minimally invasive surgical interventions for neuromuscular diseases of the esophagus (achalasia of the cardia and cardiospasm). The data of patients depending on gender, age and data of patients who needed and did not need repeated endosurgical treatment are presented. The 20-year experience of surgical treatment with the use of minimally invasive techniques in patients diagnosed with Achalasia of the cardia and cardiospasm was evaluated. The causes of relapses in both achalasia of the cardia and cardiospasm are analyzed, and the long-term results of repeated operations are presented.

Panartrodesis artroscópica de tobillo. Indicaciones, técnica y resultados

BackgroundArthroscopic tibiotalocalcaneal arthrodesis with a retrograde nail is performed as a minimally invasive technique in patients without improvement in conservative treatment of osteoarthritis. Complications and hospital stay after surgery are less using this technique when they are compared with open ones. Materials and methodsWe review retrospectively from 2016 to 2019 seven patients subjected to a posterior arthroscopic tibiotalocalcaneal arthrodesis with a retrograde intramedullary nail. AOFAS scale was used to assess functional results and we collected other data as complications, time required for bony union, time of nonweight-bearing and scale of satisfaction. We also made a description of the technique we performed. ResultsThe mean hospital stay was 3.43±0.53 days, patients have well functional results and complications were very low. It was noticed tibiotalar bony union in about 86% of patients 10 weeks after surgery and subtalar bony union in about 71% 20 weeks after surgery. Nonweight-bearing was made using a cast for 4 weeks and later, it was changed for Walker allowing patients partial weight-bearing until 10 weeks after surgery. One patient had wound complications and he needed later surgery and another presented tibiotalar pseudoarthrosis, although without symptoms. ConclusionPosterior arthroscopic tibiotalocalcaneal arthrodesis offers very good results with a high rate of bony union, few complications, and minimal nonweight-bearing time. This technique could be used in patients without major deformities, especially in those at high risk of complications from the surgical wound.

Alternative and off-label use of Titanium Elastic Nail® in acute adult humeral diaphyseal and subcapital fractures

Traumatic adult humeral diaphyseal fractures can be difficult to deal with in geriatric patients. Three examples are summarized in using Titanium Elastic Nails® (TEN) in adult patients as an efficient alternative and an off-label strategy in treating diaphyseal as well as subcapital humeral fractures. A 75 years old adult female patient suffering from a motor neuron disease with flail arm syndrome and symmetric limp paraparesis of the arms with missing reflexes of arms and legs. Plain film radiographs demonstrated a multifragmentary fracture of the diaphysis of the right humerus with slight dislocation. After fail of an initial conservative therapy attempt, the fracture was splinted intramedullary with two titanium elastic nails until fracture healing. A 59 years old female patient slipped and fell at ground level on her left side. An oblique diaphyseal humeral fracture was found. Due to an anticoagulation with clopidogrel and a major rotator cuff lesion an immediate operation was performed by minimally invasive intramedullary titanium elastic nailing. Two and a half months after surgery the fracture was fully consolidated, full weight bearing was possible four months after the surgery. The implant removal was performed five and a half months after the initial trauma without postoperative complications with full recovery of the patient and restitutio in integrum. A young female skier fell on the ski field and sustained a subcapital humerus fracture on the left side. As a primary wish of the patient getting the most minimally invasive and scar free operation, an off-label use of Titanium Elastic Nail® (TEN) was chosen and performed. The postoperative stability did allow an adequate early functional training with initially passive and active assistive motion. In conclusion, intramedullary titanium elastic nailing can be a sufficient minimally invasive technique in patients with secondary diagnoses influencing operability, bone structure and fracture healing.

Combined liver resection and radiofrequency ablation for bilobar multiple colorectal liver metastasis

Combined liver resection and radiofrequency ablation for bilobar multiple colorectal liver metastasis

Effectiveness of Invasive Techniques in Patients with Fibromyalgia: Systematic Review and Meta-Analysis.

To attain a synthesis of the evidence on the effectiveness of invasive techniques in patients with fibromyalgia, through systematic review and meta-analysis and by assessing the methodological quality of the studies considered. A systematic review and meta-analysis were carried out as defined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The bibliographic research was carried out in the PEDro, Cochrane, PubMed, Science Direct, Web of Science, Google Academics, Dialnet, and Scielo databases from September through December of 2018. Results show that invasive techniques produce a significant decrease in the pain, the impact of fibromyalgia and in the pain pressure threshold (standardized mean difference [95% confidence interval]: -0.94 [-1.44, -0.44], P of global effect= 0.0002; -0.99 [-1.69, -0.29], P of global effect= 0.006; and 0.31 [0.02, 0.61], P of global effect = 0.04, respectively). Lastly, a significant increase was observed in the quality-of-life variable after intervention (0.84 [0.30, 1.38], P of global effect = 0.002). Invasive techniques are considered effective for pain relief, as well as for producing a short-term increase in the pain pressure threshold, an improvement in quality of life, and a decrease in the impact of fibromyalgia.

Рецидиви варикозної хвороби після застосування ендовазальних термічних методик

Over the last decade, minimally invasive techniques have in fact replaced the "classic" surgery of varicose veins in the world and actively supplant it in Ukraine. But it is still not possible to radically reduce the risk of recurrence in comparison with "classical" surgery, besides the application of these methods for the treatment of recurrent forms of varicose veins (RFVV) is a significant challenge, even for an experienced phlebologist.The aim of the study was to evaluate the frequency of RFVV after application of endovascular thermal (ET) techniques and to show the results of the use of ET techniques in the treatment of RFVV.Materials and methods. The unannounced retrospective study for the period from November 2015 to April 2018 included 420 patients undergoing ET techniques, which included 86 (20.48%) patients with RFVV, of which 19 (4.52%) of patients with RFVV after treatment at your own base. Patients with RFVV underwent endovasal laser treatment (EVLT) and\or ultrasound-controlled foam sclerotherapy (UFS). 38 (44,19%) patients had EVLT, 28 (32.56%) patients UFS, 20 (23.25%) patients had EVLT in combination with UFS. After 3, 6 and 12 months, in 81 (94.19%) cases occlusion of the treated vein was observed, and in 5 (5.81%) cases a new reflux on the treated limb emerged. In all cases, the quality of life improved – the average number of VCSS points was: before treatment 5.2, in 1 month after – VCSS was 1.9; in 6 and 12 months, the number of VCSS points was 1.3.Conclusion. Repeated use of minimally invasive techniques in patients with RFVV is a technically challenging task, but has a high efficiency of 94%. Relapse rate after ET techniques corresponds to world-wide data.

MINIMALLY INVASIVE SURGICAL TREATMENT FOR ADULT DEGENERATIVE LUMBAR SCOLIOSIS

Objective. To assess the efficacy of decompression, correction, and stabilization of the lumbar spine deformity using minimally invasive techniques in patients with degenerative lumbar scoliosis. Material and Methods. A retrospective controlled two-center study included 62 patients who underwent surgery for clinical manifestations of degenerative scoliosis of the lumbar spinal canal. Results. Average Oswestry index before surgery was 69.69 %, after surgery it decreased to 33.00 % and ranged between 14 and 50 %. Average magnitude of the lumbar lordosis after surgery was 39.2°; average rate of deformity correction - 56.53 %; average magnitude of deformity reduced to 13.46° ± 6.08°. Two-fold reduction of the apical vertebra rotation was observed. Conclusion. The use of the principles of minimally invasive surgery allows to expand the indications for surgical treatment of degenerative spinal deformities and the scope of intervention, and to reduce intraoperative blood loss.

The first experience of TAPP and TEP allohernioplasty in patients with inguinal hernias at CRH

To improve the outcomes in patients with inguinal hernias by application of advanced minimally invasive procedures. The article describes an experience of 59 laparoscopic allohernioplasties in 48 patients at the central regional hospital. There were bilateral hernias in 11 cases. Transabdominal preperitoneal (n=49) and extraperitoneal (n=10) placement of polypropylene mesh graft were used. Intraoperative complications such as sigmoid colon lesion occurred in 2 patients with sliding left-sided hernia. Mortality was absent. Mean hospital-stay was 5.4 days, 12-month examination after discharge did not show any recurrent hernias. Positive results of TAPP and TEP hernia repair justify their application as minimally invasive techniques in patients with various inguinal hernias at CRH if appropriate technical training and motivation of surgical team are present.

Complex Regional Pain Syndrome in Children: a Multidisciplinary Approach and Invasive Techniques for the Management of Nonresponders.

Complex regional pain syndrome (CRPS) is multifactorial condition with complex pathogenesis characterized by spontaneous or stimulus-induced pain that is disproportionate to the inciting event. It is also commonly accompanied by a myriad of autonomic and motor disturbances in highly variable combinations. This condition has been underreported in children until recently. Consequently, the management of CRPS in the pediatric population presents an even greater challenge than in adults, partly because there is a lack of clinical data concerning the efficacy of the diverse treatment methods available, and partly because successful treatment of CRPS involves a multidisciplinary approach. In this retrospective case series, a multidisciplinary management plan is presented in 10 children for whom the standard noninvasive treatment was unsuccessful. Within this management plan, novel drugs were included such as the capsaicin 8% patch, in addition to invasive techniques in patients who did not respond to noninvasive therapies.

The Importance of Curriculum-Based Training and Assessment in Interventional Radiology

Physician performance and outcomes are being scrutinised by health care providers to improve patient safety and cost efficiency. Patients are best served by physicians who have undergone appropriate specialist training and assessment and perform large numbers of cases to maintain their skills. The Cardiovascular and Interventional Radiological Society of Europe has put into place a curriculum for training in interventional radiology (IR) and a syllabus with an examination, the European Board of Interventional Radiology, providing evidence of attainment of an appropriate and satisfactory skill set for the safe practice of IR. This curriculum is appropriate for IR where there is a high volume of image-guided procedures in vascular and nonvascular organ systems with cross-use of minimally invasive techniques in patients with a variety of disease processes. Other specialties may require different, longer, and more focused training if their experience is "diluted" by the need to master a different skill set.

Pulsion Diverticulum of the Oesophagus: More than just an Out Pouch.

Oesophageal diverticulum is divided into two types based on the aetiology: the pulsion and the traction diverticula. Pulsion diverticulum occurs due to increased intraluminal pressure. This can be of three types based on the location along the oesophagus: the Zenker's diverticulum (ZD), the mid-oesophageal diverticulum (MD) and the epiphrenic diverticulum (ED). A PubMed search was conducted for the words 'pulsion', 'diverticulum' and 'oesophagus' for all studies published from January 1980 to March 2013 in the English language. A total of 31 studies were identified, and out of which, five were not included in the review. The pulsion diverticulum of the oesophagus is an uncommon disorder. Its aetiology is related to the motility disorders of the oesophagus. Patients usually present with chest-related symptoms or oesophageal symptoms, which are related to the underlying motility disorder. Evaluation includes barium studies, gastrointestinal endoscopy, CT scan and oesophageal manometry. Surgery is the treatment of choice for symptomatic and large diverticula, although the outcome in asymptomatic patients is unknown. The surgical options include diverticulectomy or diverticulopexy with an adequate myotomy. Most patients with ZD are now treated by using endoscopic techniques, although no randomised trial has shown its superiority over the open technique. Minimally invasive surgery has also been used for patients with MD and ED. Although isolated case series has shown good improvement in symptoms and reduction in mortality with minimally invasive techniques in patients with ED, its role in thoracic oesophageal diverticulum is debated.

Minimally invasive treatment for pubic ramus fractures combined with a sacroiliac joint complex injury

Fractures of the pubic rami due to low energy trauma are common in the elderly, with an incidence of 26 per 100,000 people per year in those aged more than 60 years. The purpose of this study was to evaluate the clinical application of this minimally invasive technique in patients with pubic ramus fractures combined with a sacroiliac joint complex injury, including its feasibility, merits, and limitations. Fifteen patients with pubic ramus fractures combined with sacroiliac joint injury were treated with the minimally invasive technique from June 2008 until April 2012. The quality of fracture reduction was evaluated according to the Matta standard. Fourteen cases were excellent (93.3 %), and one case was good (6.7 %). The fracture lines were healed 12 weeks after the surgery. The 15 patients had follow-up visits between four to 50 months (mean, 22.47 months). All patients returned to their pre-injury jobs and lifestyles. One patient suffered a deep vein thrombosis during the peri-operative period. A filter was placed in the patient before the surgery and was removed six weeks later. There was no thrombus found at the follow-up visits of this patient. The minimally invasive technique in patients with pubic ramus fractures combined with a sacroiliac joint complex injury provided satisfactory efficacy.

Results of Laparoscopic Surgery for Abdominal Aortic Aneurysms in Patients With Standard Surgical Risk and Anatomic Criteria Compatible With EVAR

The recent Anévrisme de l'aorte abdominale: Chirurgie versus Endoprothèse (ACE) study showed that open surgery of infrarenal abdominal aortic aneurysms (AAAs) provided very good results in patients with standard surgical risk, with good anatomic results for endovascular aneurysm repair (EVAR). The goal of the current study was to show that aortic laparoscopy is a minimally invasive alternative to open surgery while avoiding the complications associated with laparotomy. From February 2002 to August 2010, the authors performed 239 laparoscopic AAA repairs. A subgroup of 99 patients with standard surgical risk presented with AAAs compatible with EVAR. The evaluation criteria of surgical risk and anatomic criteria compatible with EVAR corresponded to those edicted by the Agence Française de Sécurité Sanitaire des Produits de Santé and the Haute Autorité de Santé. The patients' database was prospective and the file analysis was retrospective. Digital data were given in median and extremes. The patient age was 68 years (range, 53-79 years). The aneurysmal diameter was 51 mm (range, 45-69 mm). Surgery and clamping times were 210 min (range, 180-520 min) and 81 min (range, 35-140 min), respectively. There were 60 aortic tubes and 39 bifurcated prostheses. Five patients (5%) required conversion. No hospital mortality occurred. Three patients presented with severe systemic complications (3%): 1 perioperative cardiac arrest on atrioventricular block grade 3, 1 case of febrile hypoxic atelectasis, and 1 colonic ischemia with transient renal failure with transient dialysis. Ten patients had a moderate systemic complication (10%): 7 transitory elevations of creatinemia, 1 pneumonia, 1 prostatitis, 1 sigmoiditis, and 1 cardiac arrhythmia/atrial fibrillation (CA/AF). Intensive care stay and hospitalization durations were 24 hours (range, 12-768 hours) and 6 days (range, 4-39 days), respectively. Four local complications occurred: 1 limb thrombosis, 1 compartment syndrome, 1 spleen rupture, and 1 parietal hematoma. On multivariate analysis, the overall procedure time was a predictive factor of severe systemic complications (P=0.02). Follow-up was 42 months (range, 1-97 months). Two patients required late surgery (2%): 1 for limb thrombosis after neuroendovascular procedure and 1 for iliac thrombosis. Morphologic tests did not show any defects at the aortic prosthesis level. The only abdominal complication was a rupture at the level of a laparotomy conversion. The 6 late deaths (6%) were not related to the AAA. This study shows that AAA laparoscopic surgery is a safe, long-lasting, minimally invasive technique in patients with standard surgical risk when EVAR can be considered.

Arthrocentesis for Temporomandibular Joint Pain Dysfunction Syndrome

The management of refractory temporomandibular joint (TMJ) pain is both challenging and controversial. A number of simple, noninvasive approaches have been used in the management of this condition with variable success. In patients who fail to respond to conventional conservative measures, in a joint that is not deemed to be grossly mechanically deranged, we advocate the use of TMJ arthrocentesis. In our practice, this is followed by intra-articular morphine infusion in an attempt to give long-term pain relief. Arthrocentesis is a simple technique with minimal morbidity that can be tried instead of more invasive procedures. To date we have used arthrocentesis of the upper joint space, with intra-articular morphine injection in over 500 TMJs. Approximately 90% of patients have found the procedure beneficial, with pain often being reduced 1 year after the procedure. We recommend arthrocentesis as an effective, minimally invasive technique in patients with continuing pain in the TMJ that is unresponsive to conservative management. We additionally advocate the use of intra-articular morphine as a long acting analgesic in these patients. Although arthrocentesis is a well documented technique and there have been many studies published in relation to the use of intra-articular morphine in orthopedic surgery, further research is required, to delineate its use in the TMJ more fully.

Minimally invasive anterior contralateral approach for the treatment of cervical disc herniation

Background During the practice of ipsilateral approach to the offending lesion in anterior simple discectomy, the authors realized that it achieves better surgical exposure of the opposite foraminal area. In addition, it was also realized that routine procedures for better visualization of the foraminal area, such as stripping longus colli muscles, further excising of the anterior longitudinal ligament, or using a spreader, which cause more invasive surgery during the standard anterior approach, are not necessary because the contralateral approach already achieves sufficient exposure of the target foraminal area. Objective Evaluation of the results and effectiveness of this minimal invasive technique in patients with either soft or hard disc herniations. Methods Between January 1994 and April 2002, 216 patients underwent anterior contralateral microdiscectomy without fusion for cervical disc herniation at 1 or 2 adjacent levels. Anterior contralateral microdiscectomy is a less invasive technique than standard anterior simple discectomy in which longus colli muscles are not stripped, and the lateral part of annulus fibrosis at the side of intervention and ventrolateral part of it at the opposite side are not removed. In addition, a mini Zenker handheld retractor is used for retraction of paravertebral soft tissues and a spreader is not used during the discectomy procedure. There were 182 patients diagnosed with radiculopathy and 34 patients with myelopathy. Assessments of the neurological status of patients with radiculopathy were done by physical examinations, and of those with myelopathy according to the modified Japanese Orthopaedic Association cervical spine functional assessment scale. These neurological assessments were repeated in the 18th month after surgery. In the follow-up period, the outcomes of surgery were also assessed for all patients in 4 categories, from failure to excellent. Results Surgery outcomes generally have been good to excellent and none of the patients were made worse by the procedure. The outcomes were significantly better in the radiculopathy and soft disc herniation groups. Other positive outcome factors were short duration and sudden onset of symptoms, normal cervical curvature, and single-level disease. Follow-up radiological studies revealed fibrous healing with normal or slight loss of disc height in 199 (92.1%) patients and total obliteration of the involved disc space representing radiological fusion signs in 13 (6%) patients. The overall complications observed in this study were 2 spontaneous and 2 postinfection collapses of disc level, 1 excessive fibrosis of disc level, and 2 adjacent-level diseases. Conclusion Anterior contralateral microdiscectomy without fusion achieves better exposure for resection of the offending foraminal or far lateral lesions, ventral osteophytes, or a disc fragment under direct microscopic visualization. Collapse and instability of the involved disc level can also be avoided via this less invasive technique.

An audit of 405 temporomandibular joint arthrocentesis with intra-articular morphine infusion

The management of refractory pain in the temporomandibular joint (TMJ) is both challenging and controversial. Arthrocentesis is a simple technique that can be used instead of more invasive procedures in patients with pain that fails to respond to conventional conservative measures. We undertook an audit of 405 arthrocenteses in 298 patients over a 10-year period who had refractory pain in the TMJ. The pain was assessed subjectively by a visual analogue scale, both before arthrocentesis and at 1 and 6 months, and 1 year afterwards. A significant reduction in pain score was found after arthrocentesis ( P<0.001) and 269 patients (90%) found the procedure beneficial. We recommend arthrocentesis as an effective, minimally invasive technique in patients with continuing pain in the TMJ that is unresponsive to conservative management.